Provider Demographics
NPI:1659918282
Name:STEVENS, STACEY MARIE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:MARIE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6519 W BRANHAM LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2723
Mailing Address - Country:US
Mailing Address - Phone:623-322-6143
Mailing Address - Fax:480-781-4566
Practice Address - Street 1:3930 N 30TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4607
Practice Address - Country:US
Practice Address - Phone:623-322-6143
Practice Address - Fax:480-781-4566
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235033363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1891395604OtherHELPING HANDZ COUNSELING SERVICES OUTPATIENT TREATMENT CENTER